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Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary ede...

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Autores principales: Santos, Jose L. Francisco, Zanardi, Patricio, Alo, Veronica, Rodriguez, Marcelo, Magdaleno, Federico, De Langhe, Virginia, Dos Santos, Vanina, Murialdo, Giuliana, Villoldo, Andrea, Coria, Micaela, Quiros, Diego, Milicchio, Claudio, Garcia Saiz, Eduardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658626/
https://www.ncbi.nlm.nih.gov/pubmed/34884300
http://dx.doi.org/10.3390/jcm10235599
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author Santos, Jose L. Francisco
Zanardi, Patricio
Alo, Veronica
Rodriguez, Marcelo
Magdaleno, Federico
De Langhe, Virginia
Dos Santos, Vanina
Murialdo, Giuliana
Villoldo, Andrea
Coria, Micaela
Quiros, Diego
Milicchio, Claudio
Garcia Saiz, Eduardo
author_facet Santos, Jose L. Francisco
Zanardi, Patricio
Alo, Veronica
Rodriguez, Marcelo
Magdaleno, Federico
De Langhe, Virginia
Dos Santos, Vanina
Murialdo, Giuliana
Villoldo, Andrea
Coria, Micaela
Quiros, Diego
Milicchio, Claudio
Garcia Saiz, Eduardo
author_sort Santos, Jose L. Francisco
collection PubMed
description In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach.
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spelling pubmed-86586262021-12-10 Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach Santos, Jose L. Francisco Zanardi, Patricio Alo, Veronica Rodriguez, Marcelo Magdaleno, Federico De Langhe, Virginia Dos Santos, Vanina Murialdo, Giuliana Villoldo, Andrea Coria, Micaela Quiros, Diego Milicchio, Claudio Garcia Saiz, Eduardo J Clin Med Article In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach. MDPI 2021-11-28 /pmc/articles/PMC8658626/ /pubmed/34884300 http://dx.doi.org/10.3390/jcm10235599 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Santos, Jose L. Francisco
Zanardi, Patricio
Alo, Veronica
Rodriguez, Marcelo
Magdaleno, Federico
De Langhe, Virginia
Dos Santos, Vanina
Murialdo, Giuliana
Villoldo, Andrea
Coria, Micaela
Quiros, Diego
Milicchio, Claudio
Garcia Saiz, Eduardo
Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title_full Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title_fullStr Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title_full_unstemmed Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title_short Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach
title_sort pulmonary edema in covid-19 treated with furosemide and negative fluid balance (negbal): a different and promising approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658626/
https://www.ncbi.nlm.nih.gov/pubmed/34884300
http://dx.doi.org/10.3390/jcm10235599
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